Neurotrauma Biomarker Levels and Adverse Symptoms Among Military and Law Enforcement Personnel Exposed to Occupational Overpressure Without Diagnosed Traumatic Brain Injury

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Abstract
Low-level overpressure (LLOP) is defined as the pressure caused by a shock wave that exceeds normal atmospheric pressure.1 Specially trained military and law enforcement personnel are repeatedly exposed to LLOP during training and in combat. Individually worn sensors indicate that LLOP magnitude and placement differ by source.2 Breachers use explosive charges during tactical forced entry of structures; the exposure to LLOP is a mean of 4 to 5 psi, sometimes reaching approximately 8 psi,3 monthly or annually. Hand grenade exposure among instructors may yield up to 0.5 psi4 hundreds of times per week. Exposure from 0.50-caliber rifle systems regularly exceeds 4 psi.5 Heavy-wall breaching uses high explosives, whereas sniper rifle fire uses propellant combustion, such that the time for the air pressure to increase and the total duration of air displacement differ.6,7 Despite this variance, all of these scenarios generate repeated LLOP exposures,8 and personnel affected report similar symptoms at a greater frequency than their nonexposed counterparts.9

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